| Kajo Medical Pc | |
|
2828 Highway 31 S Ste 116 Decatur AL 35603-1538 | |
| (256) 340-1500 | |
| (256) 340-1566 |
| Full Name | Kajo Medical Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 2828 Highway 31 S Ste 116, Decatur, Alabama |
| Authorized Official Name and Position | Kathleen Margaret Dupper (PRESIDENT) |
| Authorized Official Contact | 2563401500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kajo Medical Pc 2828 Highway 31 S Ste 116 Decatur AL 35603-1538 Ph: (256) 340-1500 | Kajo Medical Pc 2828 Highway 31 S Ste 116 Decatur AL 35603-1538 Ph: (256) 340-1500 |
| NPI Number | 1346612421 |
|---|---|
| Provider Enumeration Date | 10/28/2015 |
| Last Update Date | 07/01/2024 |
| Medicare PECOS PAC ID | 2961712252 |
|---|---|
| Medicare Enrollment ID | O20151117002871 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346612421 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 20222 (Alabama) | Primary |
| 213E00000X | Podiatrist | 158 (Alabama) | Secondary |
| Provider Name | Kathleen M Dupper |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023184017 PECOS PAC ID: 1456396324 Enrollment ID: I20050621001219 |
| Provider Name | Joseph R Dupper |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1447326442 PECOS PAC ID: 8123287992 Enrollment ID: I20120314000365 |
| Provider Name | Stephanie Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396306460 PECOS PAC ID: 5890027049 Enrollment ID: I20191022000278 |
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